Skip Navigation



JAC Advance Access published online on March 20, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn121
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
61/6/1348    most recent
dkn121v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Domingo, P.
Right arrow Articles by Garrido, M.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Domingo, P.
Right arrow Articles by Garrido, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

First-line antiretroviral therapy with efavirenz or lopinavir/ritonavir plus two nucleoside analogues: the SUSKA study, a non-randomized comparison from the VACH cohort

Pere Domingo1,*, Ignacio Suárez-Lozano2, Ferran Torres3, Ramón Teira4, José Lopez-Aldeguer5, Francesc Vidal6, Agustín Muñoz7, Pompeyo Viciana8, Fernando Lozano9, Antonio Vergara10, Bernadino Roca11, Ma Luisa García Alcalde12, Jaime Cosín13, Alberto Terrón14, Ma José Galindo15, Paloma Geijo16, Esteban Ribera17, Juan Gonzalez18, Trinitario Sanchez19, Juan Ramón Lacalle20 and Myriam Garrido20

1 Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08025 Barcelona, Spain 2 Hospital Infanta Elena, Ctra. Sevilla-Huelva s/n, 21080 Huelva, Spain 3 Laboratory of Biostatistics and Epidemiology (Universitat Autònoma de Barcelona), Clinical Pharmacology Service (Hospital Clinic), 08913 Bellaterra, Barcelona, Spain 4 Hospital de Basurto, Av. Montevideo 18, 48013 Bilbao, Spain 5 Hospital La Fe, Av. de Campanar 21, 46009 Valencia, Spain 6 Hospital Joan XXIII, Dr Mallafré i Guasch s/n, 43007 Tarragona, Spain 7 Hospital Infanta Cristina, Av. Elvas s/n, 06006 Badajoz, Spain 8 Hospital Virgen del Rocio, Av. Manuel Siurot s/n, 41927 Sevilla, Spain 9 Hospital de Valme, Ctra. de Sevilla-Cádiz s/n, 41014 Sevilla, Spain 10 Hospital Clinico, Av. Fermín Salvochea 34, 11510 Puerto Real, Cádiz, Spain 11 Hospital General de Castellon, Av. Benicasim s/n, 12004 Castelló de la Plana, Spain 12 Hospital de Cabueñes, Prados 395, 33394 Gijón, Asturias, Spain 13 Hospital Gregorio Marañon, Madrid, Spain 14 Hospital SAS, Ctra. Circunvalación s/n, 11407 Jerez de la Frontera, Cádiz, Spain 15 Hospital Clinico, Av. Blasco Ibáñez 17, 46010 Valencia, Spain 16 Hospital Virgen de la Luz, Hermandad de Donantes de Sangre s/n, 16001 Cuenca, Spain 17 Hospital Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain 18 Hospital Universitario La Paz, Pº de la Castellana 261, 28046 Madrid, Spain 19 Hospital Virgen del Rosell, Pº Alfonso XIII 61, 30203 Cartagena, Murcia, Spain 20 Data Management VACH Group, Betis 42, Urb Urverosa, El Rompido, 21459 Cartaya, Huelva, Spain

Received 14 January 2008; returned 20 February 2008; revised 1 February 2008; accepted 24 February 2008

* Corresponding author. Tel: +34-935565609; Fax: +34-935565938; E-mail: pdomingo{at}santpau.es/ pere.domingo{at}uab.cat

Background: Efavirenz and lopinavir/ritonavir are both recommended antiretroviral agents for combination first-line therapy, although information on direct comparisons between them is scarce. A retrospective longitudinal study from the VACH cohort comparing both regimens was performed.

Methods: Efficacy was examined comparing time to virological failure, CD4 recovery and clinical progression. Tolerability was examined comparing time to treatment discontinuation for any reason and for toxicity. Survival analysis was conducted using the Kaplan–Meier method, and standard and weighted Cox regression models.

Results: A total of 1550 antiretroviral-naive patients starting a two-nucleoside reverse transcriptase inhibitor regimen plus either efavirenz (n = 1159) or lopinavir/ritonavir (n = 391) were included in the study. At baseline, patients starting lopinavir/ritonavir had higher HIV-1 RNA and lower CD4+ cell counts. There was no difference in the adjusted hazards of virological failure [efavirenz versus lopinavir/ritonavir hazard ratio (HR) = 0.93, 95% confidence interval (CI): 0.77–1.12, P = 0.43], CD4 recovery (HR = 1.11, 95% CI: 0.95–1.30, P = 0.19) and clinical progression (HR = 0.71, 95% CI: 0.39–1.31, P = 0.27). There was an increased risk of discontinuation for any reason or for toxicity for lopinavir/ritonavir (HR = 2.10, 95% CI: 1.40–3.15, P = 0.0003). CD4 recovery with both drugs was also similar in the lowest CD4 strata. A higher risk of early hypertriglyceridaemia was associated with lopinavir/ritonavir-based regimens.

Conclusions: Our study suggests similar virological efficacy for efavirenz- or lopinavir/ritonavir-based first-line antiretroviral regimens, but an increased risk of discontinuation because of toxicity in case of lopinavir/ritonavir-based therapy. Immunological outcome appeared similar with both regimens.

Key Words: non-nucleoside reverse transcriptase inhibitors , boosted protease inhibitors , naive patients , observational study


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.